Autoinoculated palmar pustules in neonatal candidiasis
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1Department of Dermatology-UNC, Chapel Hil 27514.
Insights
Neonatal candidiasis presented unusually with unilateral upper extremity pustules in an infant. This autoinoculated infection highlights a rare manifestation of Candida in newborns.
Area of Science:
- Neonatal dermatology
- Mycology
- Infectious diseases
Background:
- Neonatal candidiasis is a common fungal infection, typically presenting in the oral cavity (thrush) or diaper area.
- Cutaneous candidiasis in neonates can manifest in various ways, but localized pustular lesions are less common.
- Autoinoculation, the transfer of infectious agents from one site to another on the same individual, can occur in infants.
Observation:
- A 2-week-old infant developed grouped pustules on the right hand, wrist, and antecubital flexure after the first week of life.
- The infant repeatedly sucked the affected areas of the hand and wrist.
- Oral and diaper candidiasis were also clinically observed.
Findings:
- Microscopic examination (Wright's stain, potassium hydroxide preparations) of pustular contents and diaper dermatitis scale confirmed the presence of pseudohyphae and budding yeasts.
- These findings were consistent with Candida infection at all involved sites.
- The unilateral upper extremity pustules were identified as an unusual, likely autoinoculated, cutaneous manifestation of neonatal candidiasis.
Implications:
- This case underscores the importance of recognizing atypical presentations of neonatal candidiasis.
- Autoinoculation from oral or diaper candidiasis to the extremities, particularly in areas of repeated infant contact like sucking, should be considered.
- Early diagnosis and appropriate antifungal treatment are crucial for managing neonatal fungal infections and preventing complications.
Abstract:
A 2-week-old infant had grouped pustules on the right hand, wrist, and antecubital flexure that appeared after the first week of life. The infant was seen repeatedly to suck the involved areas of the hand and wrist. Clinically typical candidiasis was noted in the oral cavity and the diaper area. Wright's-stained smears of pustular contents, potassium hydroxide preparations of pustular material, and scale from the diaper dermatitis confirmed the presence of pseudohyphae and budding yeasts in all the involved sites. This case demonstrates fairly typical manifestations of neonatal-onset candidiasis, with the unusual feature of unilateral upper extremity pustules that appeared to represent an autoinoculated cutaneous infection.